Minimal clinically important difference for the Jamar Hand Grip Dynamometer in CIDP: a Korea-UK study
Min, Young Gi Rajabally, Zeinab Ju, Woohee Lee, Jiwon Choi, Jiwon Mistry, Niraj Choi, Seok-Jin Kim, Sung-Min Hong, Yoon-Ho Rajabally, Yusuf A
Min, Young Gi
Rajabally, Zeinab
Ju, Woohee
Lee, Jiwon
Choi, Jiwon
Mistry, Niraj
Choi, Seok-Jin
Kim, Sung-Min
Hong, Yoon-Ho
Rajabally, Yusuf A
Affiliation
Seoul National University Hospital; Seoul National University College of Medicine; University Hospitals Birmingham NHS Foundation Trust; Chung-Ang University Hospital; Chung-Ang University College of Medicine; Seoul National Boramae Medical Center; Aston University
Other Contributors
Publication date
2025-08-25
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Introduction/aim: Grip strength (GS) is widely used in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Current guidelines recommend a 10% relative change as the minimal clinically important difference (MCID) to determine response to treatment, preferably based on the average of three consecutive daily measurements. However, appropriate thresholds remain unclear for identifying deterioration and for situations where daily monitoring is not feasible.
Methods: We analyzed 350 GS assessments from 122 CIDP patients across 2 neuromuscular centers in Korea and the UK. Clinical changes were classified as improved, deteriorated, or stable based on the patient's perception of change and validated outcome measures: Inflammatory Neuropathy Cause and Treatment (Korea), Overall Neuropathy Limitation Scale (UK), and Inflammatory Rasch-built Overall Disability Scale (both sites). The Youden index was used to determine optimal MCID thresholds for absolute (kg) and relative (%) changes for improvement and deterioration, respectively. The performance of derived cut-offs was compared with previously proposed thresholds.
Results: The guideline-recommended 10% relative threshold showed notably low specificity and accuracy despite high sensitivity for both improvement and deterioration. Our derived thresholds, 5 kg for improvement, 4.5 kg for deterioration, and 20% for either direction of change, offered significantly higher specificity and accuracy.
Conclusion: Our findings highlight the need for more stringent thresholds than current recommendations when assessing patients based on single-day measurements. Our proposed thresholds, double in amplitude of the currently guideline-recommended relative value but close to that previously derived for the absolute cut-off, offer improved diagnostic specificity, which may ensure more reliable monitoring in routine care.
Citation
Min YG, Rajabally Z, Ju W, Lee J, Choi J, Mistry N, Choi SJ, Kim SM, Hong YH, Rajabally YA, Sung JJ. Minimal Clinically Important Difference for the Jamar Hand Grip Dynamometer in CIDP: A Korea-UK Study. Eur J Neurol. 2025 Aug;32(8):e70335. doi: 10.1111/ene.70335.
Type
Article